Eccentric strain at long muscle length evokes the repeated bout effect

The repeated bout effect (RBE) is a phenomenon characterized by less delayed onset muscle soreness (DOMS) and torque deficit after the second of 2 separate eccentric exercise bouts. Previous investigators have reported that shifting of optimum angle after an initial bout of eccentric exercise mediates the RBE. We hypothesized that an RBE for elbow extensor exercise occurs after an initial bout performed at long (starting position of 50 degrees to an end position of 130 degrees) but not short (starting position of 0 degrees to an end position of 80 degrees) muscle length because strain at long length evokes a shifting of the optimum angle to a longer length. Untrained women performed an initial bout at either long or short length (n = 9 per group) followed 1 week later by a repeated bout (RB) through the full ROM (0-130 degrees). Extensor torque and optimum angle was evaluated before, immediately after, and 2 days after each bout. A mechanical transducer depressed on the triceps brachii quantified DOMS. Torque deficits were 3% and 7% after exercise at short vs. long length, respectively. Two days after the RB, torque deficit was 8% and 1% for those previously exercising at short vs. long length (group x bout, p < 0.05). Greater DOMS (N) was observed after exercise at long (16 +/- 3) vs. short (23 +/- 2) length; whereas greater DOMS occurred for the short-length (17 +/- 2) vs. long (26 +/- 3) group after the RB (group x bout, p < 0.05). Optimum angle shifted to a longer length after exercise at long (+10 +/- 4 degrees) vs. short (+1 +/- 3 degrees) length (group x bout, p < 0.05). After the RB, those exercising previously at short length experienced a shift of +15 +/- 4 degrees (main effect, p < 0.05). The findings of this study indicate that the repetitive strain at long but not short muscle length evokes both immediate and sustained shifts in optimum angle to longer lengths, and that this shifting mediates (r(2) = 0.71) the RBE.

Pilocarpine-induced sweat gland function in individuals with multiple sclerosis

This investigation tested the hypothesis that cholinergic sweat function of individuals with multiple sclerosis (MS) (MS-Con; n = 10) is diminished relative to matched healthy control subjects (Con; n = 10). In addition, cholinergic sweat function was determined before and after 15 wk of aerobic training in a subgroup of individuals with MS (MS-Ex; n = 7). Cholinergic sweating responses were assessed via pilocarpine iontophoresis on ventral forearm skin. A collection disk placed over the stimulated area collected sweat for 15 min. Sweat rate (SR) was calculated by dividing sweat collector volume by collection area and time. Iodine-treated paper was applied to the stimulated area to measure number of activated sweat glands (ASG). Sweat gland output (SGO) was calculated by dividing SR by density of glands under the collector. Sweat gland function was determined in MS-Ex to test the hypothesis that exercise training would increase sweating responses. No differences in ASG were observed between MS-Con and Con. SR and SGO in MS-Con [0.18 mg·cm−2·min−1(SD 0.08); 1.74 μg·gland−1·min−1(SD 0.79), respectively] were significantly lower ( P ≤ 0.05) than in Con [0.27 mg·cm−2·min−1(SD 0.10); 2.43 μg·gland−1·min−1(SD 0.69)]. Aerobic exercise training significantly ( P ≤ 0.05) increased peak aerobic capacity in MS-Ex [1.86 (SD 0.75) vs. 2.10 (SD 0.67) l/min] with no changes in ASG, SR, and SGO. Sweat gland function in individuals with MS is impaired relative to healthy controls. Fifteen weeks of aerobic training did not increase stimulated sweating responses in individuals with MS. Diminished peripheral sweating responses may be a consequence of impairments in autonomic control of sudomotor function.

Treatment of multiple sclerosis with an anti-interleukin-2 receptor monoclonal antibody

We examined whether treatment with daclizumab, a humanized monoclonal antibody specific for the interleukin-2 receptor alpha chain, was safe and efficacious in relapsing-remitting and secondary progressive multiple sclerosis patients. Nineteen ambulatory patients with clinically active disease were treated for 5 to 25 months. Seventeen patients were not responding to other immunotherapies. Daclizumab was generally well tolerated. Sustained clinical improvement (10 patients) or stabilization (9 patients) was observed. Daclizumab treatment produced significant reduction in magnetic resonance imaging activity.

Physiological measures of therapeutic response to interferon beta-1a treatment in remitting-relapsing MS

OBJECTIVE

This pilot study was designed to determine the effects of interferon beta-1a (IFNB) therapy (Avonex) on cortically evoked motor potentials (MEPs) during resting and fatigued states in individuals with multiple sclerosis (MS).

METHODS

Eight women with relapsing-remitting MS (mean age 36) and mean Expanded Disability Status Scale (EDSS) score of 3.1 were evaluated before and after 3, 6, and 12 months of IFNB therapy. At each test period, MEPs were recorded at rest and following a fatigue paradigm (3 min maximal contraction). Effects of IFNB on neurological and functional (7.7 m walk and 10 s finger tapping) status and fatigue were also examined.

RESULTS

Recovery from post-exercise depression of MEP amplitudes (PED) was 41, 43, and 43.5% faster at 3, 6, and 12 months, respectively, compared to baseline (P < 0.05). Percent reduction of MEP amplitude was significantly less at 6 months (P < 0.05) The majority of subjects (5/8 at 3 months; 6/8 at 6 and 12 months) reported decreased physical fatigue. Functional improvements were observed for walk and finger tapping scores after 3 months of IFNB treatment. MEP latencies were unchanged over the course of the intervention.

CONCLUSIONS

Results indicate that IFNB therapy may improve the rate of recovery from central fatigue.

SIGNIFICANCE

Transcranial magnetic stimulation (TMS) may have promise as an objective physiological tool to evaluate disease activity and treatment responses in MS.

Metabolic, thermoregulatory, and perceptual responses during exercise after lower vs. whole body precooling

The purpose of this investigation was to compare the thermoregulatory, metabolic, and perceptual effects of lower body (LBI) and whole body (WBI) immersion precooling techniques during submaximal exercise. Eleven healthy men completed two 30-min cycling bouts at 60% of maximal O(2) uptake preceded by immersion to the suprailiac crest (LBI) or clavicle (WBI) in 20 degrees C water. WBI produced significantly lower rectal temperature (T(re)) during minutes 24-30 of immersion and lower T(re), mean skin temperature, and mean body temperature for the first 24, 14, and 16 min of exercise, respectively. Body heat storage rates differed significantly for LBI and WBI during immersion and exercise, although no net differences were observed between conditions. For WBI, metabolic heat production and heart rate were significantly higher during immersion but not during exercise. Thermal sensation was significantly lower (felt colder) and thermal discomfort was significantly higher (less comfortable) for WBI during immersion and exercise. In conclusion, WBI and LBI attenuated T(re) increases during submaximal exercise and produced similar net heat storage over the protocol. LBI minimized metabolic increases and negative perceptual effects associated with WBI.

Thermal regulatory responses to submaximal cycling following lower-body cooling in humans

This study compared the effects of pre-exercise cooling with control water immersions on exercise-induced thermal loads derived from steady-state submaximal exercise. Eight healthy male participants [mean (SEM) age 29 (1) years, maximal oxygen uptake 3.81 (0.74) l x min(-1), and body surface area 1.85 (0.11) m(2)] took part in experiments that included 30 min of baseline data collection [ambient temperature 21.3 (0.2 degrees C)], 30 min of immersion in water to the level of the supra-iliac crest [water temperatures of 35.1 (0.3) degrees C for thermoneutral and 17.7 (0.5) degrees C for precooled treatments], and 60 min of cycling exercise at 60% of maximal oxygen uptake. No significant differences were noted during exercise in net mechanical efficiency, metabolic rate, O(2) pulse, or ratings of perceived exertion between the two treatments. Precooling resulted in a significant negative body heat storage during immersion and allowed greater heat storage during exercise. However, net body heat storage for the entire protocol was no different between treatments. Cooling significantly lowered rectal, mean skin, and mean body temperatures as well as more than doubling the exercise time until a 0.5 degrees C rectal temperature increase was observed. The cooling trial significantly delayed onset of sweating by 19.62 min and decreased sweat rate by 255 ml x h(-1) compared to control. Thermal and sweat sensation scores were lower after the cooling treatment compared to control. These data suggest that lower-body precooling is effective at decreasing body heat storage prior to exercise and decreases reliance on heat dissipation mechanisms during exercise. Therefore, this unique, well-tolerated cooling treatment should have a broader application than other precooling treatments.

Motor-evoked potentials in response to fatiguing grip exercise in multiple sclerosis patients

OBJECTIVE

This study examined central and peripheral effects of fatiguing exercise (3 min maximal grip) in healthy controls (n=10) and multiple sclerosis (MS) subjects with weakness, MS-W (n=16) and normal motor function, MS-NM (n=16) in the studied extremity.

METHOD

Transcranial magnetic stimulation (TMS) was used to assess resting and facilitated motor-evoked potentials (MEPs) of abductor pollicus brevis (APB) and flexor carpi radialis (FCR) muscles before and after fatiguing exercise. Exercise-induced depletion and recovery of phosphocreatine (PCr) were measured using (31)P magnetic resonance spectroscopy ((31)PMRS) in FCR.

RESULTS AND CONCLUSION

MS subjects demonstrated significantly lower peak force and a faster decline in force than controls. Contralateral muscle activation (hand grip) before the fatigue protocol resulted in significantly increased MEP amplitudes in all groups. Contralateral hand grip following fatiguing exercise resulted in significantly higher MEP amplitudes in controls and MS-NM subjects, but not MS-W subjects. Fatiguing exercise resulted in prolonged central motor conduction time (CMCT) in MS subjects, but not controls. No group differences in PCr depletion or resynthesis were observed. All groups demonstrated significant post-exercise depression (PED) of MEP amplitude that persisted beyond the time course of PCr recovery, indicating fatigue was central in origin. MS subjects were less able than controls to increase cortical excitability using contralateral muscle activation following fatiguing exercise, possibly indicating impaired conduction in the corpus callosum.

Effect of precooling on physical performance in multiple sclerosis

Many individuals with MS experience heat sensitivity that may be associated with transient increases in the frequency of clinical signs and symptoms. Although physical activity may be beneficial for those with MS, induced thermal loads may preclude participation in exercise and other daily activities. This project was designed to evaluate the effects of precooling on physical function. Six thermosensitive MS patients were studied. Participants performed a graded exercise test to determine maximal oxygen uptake (VO2max) on a combined arm-leg ergometer. Thermal load was induced by 30 min of exercise under noncooled and precooled conditions at a workrate corresponding to 60% VO2max. Precooling consisted of 30 min lower body immersion in 16 - 17 degrees C water. Fatigue and 25-ft walk performance were assessed before, immediately after, and 30 min following exercise. No treatment differences in VO2 were observed. Rectal temperature, heart rate, and rating of perceived exertion (RPE) were significantly lower during the precooled exercise trial compared to the noncooled trial. Immediately following exercise, 25-ft walk performance and fatigue scores showed significantly greater deterioration in the noncooled condition. Precooling was effective in preventing gains in core temperature with physical work and may allow heat-sensitive individuals with MS to exercise with greater physical comfort.

Recommendations for physical activity in patients with multiple sclerosis

For many years, patients with multiple sclerosis (MS), an inflammatory demyelinating disease of the central nervous system, have been advised to avoid exercise. MS is believed to be autoimmune in origin, mediated by activated T cells which penetrate the blood-brain barrier and attack myelin. The pathophysiology, with respect to function is an impairment of saltatory conduction, specifically, slowing of conduction speed and/or conduction block. Symptoms can temporarily worsen on exposure to heat or during physical exercise. Exercise programmes must be designed to activate working muscles but avoid overload that results in conduction block. Fatigue, often severe, affects about 85% of MS patients and, along with motor and sensory symptoms, results in decreased mobility and reduced quality of life. Physical activity and recreation are reduced in patients with MS. Before developing recommendations, physical activity patterns and the physical effects of MS should be assessed in individual patients. Patients may then be functionally classified. Physical activity can also be classified in a pyramid structure, with the most basic functions forming the base and the most integrated functions on top. The muscular fitness pyramid progresses through passive range of motion, active resistive, specific strengthening and integrated strength exercises Overall physical activity may be increased according to functional level by performing activities of daily living, incorporating inefficiencies into daily living, pursuing more active recreation and eventually developing a structured exercise programme. The importance of the proper exercise environment, balance and coordination issues and factors related to adherence are discussed.

The physiological effects of beverage ingestion during cross country ski training in elite collegiate skiers

The purpose of this study was to investigate the effects of beverage ingestion on fluid balance during 1.5 hr of low intensity cross country skiing. In Part I, 6 skiers drank water ad libitum during ski training. In Part II, 10 skiers were matched by body weight (BW) and assigned to ingest 2.5 ml.kg-1 BW of water or a carbohydrate/electrolyte (CE) beverage every 2.5 km. Skiing speed averaged 11.5 km.hr-1 for 90 min around a 5 km groomed track. Following 20 min of seated rest, blood samples were collected immediately before and approximately 30 min after skiing. Part I data indicated that subjects ingested 576 +/- 189 ml of fluid and produced 266 +/- 205 ml of urine; BW, plasma and urine osmolality, and plasma protein decreased significantly. In Part II, the CE group produced less urine (135u75 vs. 450 +/- 262 ml) and had smaller decreases in plasma osmolality (-1.0 +/- 1.0 vs. -7.0 +/- 2.4 mOsm.kg H2O) and protein (-0.11 +/- 08 vs. -0.42 +/- 0.24 gL-1) than the water group. No differences were observed for BW loss, % change in PV, FWC, or change in urine osmolality. It was concluded that ad lib water ingestion was inadequate to minimize fluid balance disruption. Plain water ingestion also led to significant dilution of the plasma and increased urine output. However, the ingestion of CE led to attenuation of fluid balance disruption, presumably due to the maintenance of osmotic balance in the plasma.

Impact of aerobic training on fitness and quality of life in multiple sclerosis

Fifty-four multiple sclerosis (MS) patients were randomly assigned to exercise (EX) or nonexercise (NEX) groups. Before and after 15 weeks of aerobic training, aspects of fitness including maximal aerobic capacity (VO2max), isometric strength, body composition, and blood lipids were measured. Daily activities, mood, fatigue, and disease status were measured by the Profile of Mood States (POMS), Sickness Impact Profile (SIP), Fatigue Severity Scale (FSS), and neurological examination. Training consisted of 3 x 40-minute sessions per week of combined arm and leg ergometry. Expanded Disability Status Scale (EDSS) scores were unchanged, except for improved bowel and bladder function in the EX group. Compared with baseline, the EX group demonstrated significant increases in VO2max, upper and lower extremity strength, and significant decreases in skinfolds, triglyceride, and very-low-density lipoprotein (VLDL). For the EX group, POMS depression and anger scores were significantly reduced at weeks 5 and 10, and fatigue was reduced at week 10. The EX group improved significantly on all components of the physical dimension of the SIP and showed significant improvements for social interaction, emotional behavior, home management, total SIP score, and recreation and past times. No changes were observed for EX or NEX groups on the FSS. Exercise training resulted in improved fitness and had a positive impact on factors related to quality of life.

Physiological aspects and injury in elite Alpine skiers

Alpine skiing requires aerobic and anaerobic power, muscular strength, and a variety of complex motor abilities including quickness, agility, balance and coordination. There is evidence of variability in physical characteristics between skiers of different events. Generally, successful alpine competitors are taller and heavier than in the past. Greater size, specifically lean mass, may be related to technique changes because of the advent of breakaway poles. Aerobic power, although important, does not discriminate competitors of varying ability categories. Aerobic power is more likely to be a result of conditioning for alpine skiing rather than a profound requirement of the sport. Anaerobic power is important for skiing and both laboratory and field power tests correlate well with performance. Tests that measure explosive and sustained anaerobic power such as the Wingate, vertical jump, 60-second repeated jump, and Margaria-Kalamen stair run are valuable in assessing skiers. On-snow lactate and oxygen consumption measurements further substantiate the need for high anaerobic power. Alpine skiers have very high leg strength compared with other athletes. Isokinetic testing has been used to evaluate dynamic leg strength in skiers, but little is known about high speed dynamic or eccentric strength capabilities. A new mechanism of knee injury that is associated with tibial acceleration has been identified in competitive alpine skiers. A release binding that is sensitive to physiological factors in addition to release forces should be developed. Strength profiling of skiers may also be valuable in evaluating injury risk.

Human infection by genetically diverse SIVSM-related HIV-2 in west Africa

Our understanding of the biology and origins of human immunodeficiency virus type 2 (HIV-2) derives from studies of cultured isolates from urban populations experiencing epidemic infection and disease. To test the hypothesis that such isolates might represent only a subset of a larger, genetically more diverse group of viruses, we used nested polymerase chain reactions to characterize HIV-2 sequences in uncultured mononuclear blood cells of two healthy Liberian agricultural workers, from whom virus isolation was repeatedly unsuccessful, and from a culture-positive symptomatic urban dweller. Analysis of pol, env and long terminal repeat regions revealed the presence of three highly divergent HIV-2 strains, one of which (from one of the healthy subjects) was significantly more closely related to simian immunodeficiency viruses infecting sooty mangabeys and rhesus macaques (SIVSM/SIVMAC) than to any virus of human derivation. This subject also harboured multiply defective viral genotypes that resulted from hypermutation of G to A bases. Our results indicate that HIV-2, SIVSM and SIVMAC comprise a single, highly diverse group of lentiviruses which cannot be separated into distinct phylogenetic lineages according to species of origin.

Non-specific abdominal pain: the resource implications

Non-specific abdominal pain (NSAP) is responsible for a significant proportion of emergency surgical admissions with resultant resource implications. The extent of the problem was assessed in a consecutive group of 100 patients, aged between 15 and 35 years, admitted with lower abdominal pain to one general surgical firm. No less than 67 of these patients (67%) were diagnosed as having NSAP (13.29% of all general surgical admissions), most (75%) being female and having a mean hospital stay of 4.1 days. Only 11 patients (11%) had appendicitis and the remaining 22 had miscellaneous gynaecological, urological or gastrointestinal problems. Detailed analysis of the resources used revealed that the mean cost to the NHS of each case of NSAP was 807 pounds, the bulk of which was attributable to the hospital stay. Wider assessment of the problem (by means of postal questionnaire) suggests that the cost to the NHS in Wales is in the region of 6 million pounds per year and may be over 100 million pounds per year in the UK as a whole.

Physiological comparison of international, national and regional alpine skiers

The purpose of this study was to evaluate the predictive power of physiological tests in categorizing competitive alpine skiers. Sixty-one subjects (30 female and 31 male) were classified into three levels: international, national, and regional on the basis of past competition results. Hydrostatic weighing, maximal cycling, Wingate, 60-s repeated jump, and vertical jump tests were used to assess body composition, aerobic and anaerobic power, respectively. MANOVA revealed a significant group by gender interaction (Hotellings T, p less than .001), and main effects of gender and group (p less than .001). Discriminant analyses performed separately for male and female groups determined which variables were responsible for differences and resulted in selection of the following variables for classification of the men: average work from the repeated jump, absolute power for the vertical jump, and Wingate endurance. For the women, average work from the repeated jump, absolute and relative vertical jump power, absolute maximum Wingate power, and relative repeated jump power were most important. Fat-free mass was a powerful predictor for both sexes because of its strong relationship (r greater than 0.85) with power results. Aerobic power was not useful in group classification. In conclusion, physiological tests of anaerobic power and fat-free mass were the best predictors of group membership.

Improvement in severe onchocercal skin disease after a single dose of ivermectin

PURPOSE

Skin disease is the most common clinically important manifestation of onchocerciasis. Ivermectin, a newly available drug, is well tolerated and effective in Onchocerca volvulus infection. However, little information is available regarding its effect on onchocercal skin disease. The purpose of this study was to examine, in patients with well-characterized onchodermatitis, the effect of a single dose of ivermectin.

SUBJECTS AND METHODS

Twenty-one persons with severe onchodermatitis were followed over a 6-month period. In order to evaluate the effect of ivermectin on their skin lesions, photographic transparencies were made before treatment and at 3 and 6 months after treatment. These were then evaluated in a blinded fashion.

RESULTS

Following a single dose of 150 micrograms/kg, there was a significant improvement in dermatitis in the first 3 months after treatment. All 14 persons with the worst skin disease showed improvement. The drug had no demonstrable effect on depigmented lesions over the period of observation. Treatment was well tolerated.

CONCLUSION

Single-dose ivermectin shows promise as the first acceptable treatment for severe onchocercal dermatitis.

Ocular manifestations of onchocerciasis in a rain forest area of west Africa

The epidemiology and natural history of onchocerciasis and its ocular complications in rain forest areas are poorly understood. The present study was conducted on a rubber plantation in a hyperendemic area in the rain forest of Liberia, West Africa, where 800 persons were examined. The prevalence of infection was 84% overall 29% had intraocular microfilariae, and 2.4% were blind in one or both eyes. Onchocerciasis was the cause of all binocular blindness and one-third of all visual impairment. Over half of the visual impairment caused by onchocerciasis was due to posterior segment diseases. Chorioretinal changes were present in 75% of people, and included intraretinal pigment clumping in 52% and retinal pigment epithelium atrophy in 32%. Atrophy of the retinal pigment epithelium was associated with increasing age and severity of infection. Intraretinal pigment was strongly associated with anterior uveitis. There was a strong correlation between uveitis and the inflammatory chorioretinal sequelae: retinitis, intraretinal pigment, subretinal fibrosis, and optic neuropathy. These findings indicate that considerable visual impairment associated with rain forest onchocerciasis is common and is due largely to chorioretinal disease.

A comparison of 6-, 12-, and 24-monthly dosing with ivermectin for treatment of onchocerciasis

This study was designed to examine the optimal dose and interval of administration of ivermectin, the now-accepted drug of choice for onchocerciasis. Two hundred Liberians with Onchocerca volvulus infection received 100, 150, or 200 micrograms/kg ivermectin or placebo and were followed for 36 months. The reaction after the second dose of ivermectin was significantly less than after the initial dose, although it was still significant in the 200-micrograms/kg group. The skin microfilaria counts in the group treated 6-monthly with 150 micrograms/kg was significantly less than in the group treated yearly (12 and 24 months after initial therapy). Prevalence of microfilariae in the anterior chamber and punctate corneal opacities decreased progressively in all groups over 3 years. There appears to be a slight advantage, in terms of antiparasitic effect over the first 2 years, of therapy given 6-monthly compared with yearly.

Grand rounds revisited: results of a survey of U.S. Departments of Medicine

Medical grand rounds is a time-honored weekly conference at United States teaching hospitals. We surveyed 122 departments of medicine to test the hypothesis that grand rounds may have changed with the changing training environment. Our goal was to gain a new perspective on the way physicians learn clinical medicine and maintain their fund of information. A questionnaire was designed to assess several aspects of grand rounds, including format, objectives, popularity, and changes over time. The questionnaire was directed to department heads of 122 U.S. medical schools. Seventy-five percent of respondents were department chairs; the remainder were chief residents and other faculty. Survey response rate was 96%. According to respondents, the major objective of grand rounds was to provide "updates in diagnosis and treatment." Case presentations were regularly included in about one third of departments; patients were rarely present for examination or interview. The popularity of grand rounds was thought to have decreased. These data support the impression that medical grand rounds is still considered important in most academic medical centers. Suggestions are made for increasing the clinical relevance of the conference. New techniques for presenting clinical material are reviewed, and an argument is made for returning to a basic strategy of "solving the patient's problem."

Safety of and compliance with community-based ivermectin therapy

In a study of the safety, acceptability, and efficacy of ivermectin for community-based mass treatment of onchocerciasis, the drug was issued twice, one year apart, to the population of a rubber plantation (14,000 people) in Liberia, where over 80% of the adults have Onchocerca volvulus infection. The plantation microfilarial load in a sample of adults was reduced by 86% 6 months after initial treatment and by 78% after 1 year. Compliance was 97% with each round of treatment. After the initial treatment of 7699 people, 101 (1.3%) had moderate adverse reactions. After re-treatment only 37 (0.5%) people had moderate adverse reactions. No ivermectin-related death or severe adverse reactions occurred. The data show that community-based treatment with ivermectin is well accepted and effective in reducing microfilarial loads. Ivermectin is likely to provide the first realistic means of chemotherapy-based control of onchocerciasis on a mass scale.